2015 ANNUAL REPORT

Douglas J. Springer, MD, FACP, FACG Kingsport gastroenterologist TMA President 2014-2015

John W. Hale, Jr., MD Union City family physician TMA President 2015-2016

Leading and representing a volunteer organization comprising 8,500 of your peers is a tremendous responsibility. It also instills an entirely new sense of pride for all the progress we are making toward our mission of establishing a better environment for the practice of medicine in Tennessee.

In 2015 we galvanized physicians toward this purpose and realized one of the largest membership increases in the past decade.

We rallied doctors behind physician-led, team-based care, payer accountability and other big issues. We identified threats and opportunities for our patients and profession, and we did something about them by giving doctors a clear rallying point in their state medical society.

We expanded our education offerings, leveraging our accreditation to produce more original CME.

We created training programs to help young physicians develop the leadership skills they need to champion emerging healthcare delivery models.

We invested time, energy and resources in outreach to local areas, touring the state to make sure physicians know that the TMA is here, why it is here and what the organization is doing for them on a daily basis.

We developed new, stronger and more meaningful partnerships with the business side of medicine, working with CEOs, practice administrators and other decision makers to identify ways we can achieve common goals in changing practice environments.

We strengthened every major operational area in 2015 to improve the overall health of the organization, and position TMA for even bigger and better things ahead.

None of this is possible, however, without engaged members who actively contribute their time, money and talents.

Thank you for your support.

It is an honor and privilege to serve you.

YEAR IN REVIEW

TMA achieved a 6% year-over-year membership increase in 2015, exceeding membership budget, surpassing 8,500 total members and reaching its highest dues-paying membership total in nearly a decade.

While the ebbs and flows of membership can be driven by hot-button issues, gains realized in 2015 were the direct result of a strategic, aggressive marketing campaign to increase general awareness, communicate the TMA value proposition and proactively seek out group deals. The campaign targeted every type of physician in some fashion, from newly licensed physicians moving into the state, to those practicing in employed environments to those practicing in areas without a functioning county medical society.

A once sparse and disjointed library of marketing materials was replaced with a full arsenal of new tools to support member recruitment, engagement and retention, including tools to empower physician leaders to engage in effective peer-to-peer communication, recruit more members and build on the momentum created in 2015.

The TMA website was completely redesigned to make it easier for physicians to join and renew their memberships online, and more web-based payments were collected than in any previous year.

The TMA Membership Committee also developed a new model for discounts on member dues. The simplified approach to dues pricing gives individuals and small groups a chance to earn discounts, and assigns fair and consistent rewards for larger groups with 100% membership.

tnmed.org/membership

MEMBERSHIP REVIVAL

NEW FOR 2O16

Be sure to take advantage of these exciting opportunities in the coming months.

PITCH – Physicians Involved in Tennessee’s Capitol Hill

Our grassroots advocacy program has been expanded to include more opportunities for physicians to

make sure their voice is heard on Capitol Hill and across the state. tnmed.org/grassroots or

rebecca.lofty@tnmed.org

John Ingram Institute for Physician Leadership

TMA offers two new tracks for physicians to acquire skills to help them impact their practices, their

communities and their profession. tnmed.org/leadership or angie.madden@tnmed.org

Day on the Hill – March 2016, Nashville

TMA’s annual policy briefing and lobby day in Nashville connects physicians directly with state lawmakers

so they can advocate for their patients and discuss major issues affecting the medical profession in

Tennessee. tnmed.org/dayonthehill

MedTenn Annual Convention – April 28-May 1, Murfreesboro

MedTenn is the premiere annual convention for physicians and medical professionals in Tennessee.

Sponsored by the TMA and the largest medical specialty societies from across the state, the four-day

event features a robust lineup of proprietary education, professional networking and social activities.

tnmed.org/MedTenn

Online CME

Access proprietary on-demand CME courses, including two hours of proper prescribing required by the

Board of Medical Examiners. tnmed.org/education

2O16

MEMBERSHIP ROI

advocacy

education

leadership

insurance

doctors

employers legal

business

groups

YOU ARE STRONGER WITH TMA IN

YOUR CORNER, BUT WE NEED YOUR

MEMBERSHIP TO FIGHT YOUR FIGHTS.

We invite you to become a member of

your state medical society.

The Tennessee Medical Association is

the largest professional organization

for physicians in Tennessee, representing

doctors in all specialties across the state.

We’ve been looking out for physicians

like you since 1830.

Physicians like you make sure our state

lawmakers and regulators respect the

practice of medicine. They want to grow

professionally and acquire new leadership

skills. They collaborate with other

healthcare leaders on innovative care

models. They protect their relationships

with their patients. They are champions

for public health.

Physicians like you take pride in their

profession.

Physicians like you are the TMA.

PLUG IN.NOT A TMA MEMBER?

We need your membership!

Complete the enclosed membership application, or:

VISIT www.tnmed.org/join

CALL 615.385.2100

EMAIL membership@tnmed.org

Joining the TMA gets you access to professional

resources you can’t get anywhere else and gives you

an influential voice at the state level. We have the size

and experience to win on public policy issues, and

constantly strive to improve the quality, prosperity

and enjoyment of being a Tennessee physician. We

can even save you money on things you already buy.

The value of your membership in the TMA far

outweighs the cost.

ALREADY A TMA MEMBER?

Membership in the TMA is at a 10-year high. Help us

build on this momentum by inviting a colleague to

join the TMA. Urge them to complete the enclosed

membership application, and tell them we need more

good physicians like them to get involved. There is no

better way to grow membership in our association

than through peer-to-peer communication.

Abercrombie Radiological Consultants

Adams Patterson Gynecology & Obstetrics

Allergy and ENT Associates of Middle Tennessee

Alliance of Cardiac, Thoracic & Vascular Surgeons

American Anesthesiology

Anderson Rahman Dermatology

Anesthesia Medical Group, a PhyMed Company

Anesthesiology Consultants Exchange

Appalachian Neurological Clinic

Arthritis Associates

Associated Orthopedics of Kingsport

Associates in Diagnostic Radiology

Associates in Oncology & Hematology

Associates in Plastic & Reconstructive Surgery

Baptist Medical Group

Baptist Memorial Healthcare

Beacon Health Alliance

Blount Memorial Physicians Group

Blue Ridge Neuroscience Center

Bristol Anesthesia Services

Campbell Clinic Orthopaedics

Center for Sports Medicine & Orthopaedics

Chattanooga Allergy Clinic

Chattanooga Bone & Joint Surgeons

Chattanooga Center for Women

Chattanooga Ear Nose & Throat Associates

Chattanooga Emergency Medicine

Chattanooga Eye Institute

Chattanooga Heart Institute

Chattanooga Neurology Associates

Chattanooga Women’s Specialists

Cherokee Health Systems (Chattanooga)

CHI Memorial Health Partners

Cleveland Eye Clinic

Consultants in Pain Management

Cookeville Pediatric Associates

Core Physicians

Dermatology Associates of Kingsport

Dermatology Associates of Knoxville

Diagnostic Cardiology Group

Diagnostic Pathology Services

DiStefano Regional Eye Center

Drs. Davenport and Davenport, Elizabethton

Ear Nose and Throat Consultants of East Tennessee

East Memphis Orthopedic Group

East Ridge Eye Center

East Tennessee Brain and Spine

East Tennessee Spine and Ortho of Morristown

East Tennessee Vascular Center, Morristown

Erlanger Health System Physician Groups

Fenyves and Fry

Fertility Center of Chattanooga

Galen Medical Group

Gastroenterology Associates of Chattanooga

Goodlettsville Pediatrics PC

Greeneville Orthopaedic Clinic

Greeneville Pediatric Clinic

Greeneville Surgical Associates

Hamblen Anesthesia

Hamblen Pediatric

Hamilton Eye Institute

Hayes Hand Center

Head and Neck Specialties

Heritage Medical Associates

Infectious Disease Physicians of Chattanooga

Inpatient Physicians of the Mid-South

Jackson Pathology Group

Jackson Surgical Associates

Jefferson Family Physicians

Johnson City OB/GYN Associates

Knoxville Pediatric Associates PC

Knoxville Radiology Group

Lakeway Dermatology Associates

Lakeway Anesthesia

Lakeway Ear, Nose and Throat

McDonald Murrmann Women’s Clinic

Medical Anesthesia Group

Memphis Dermatology Clinic

Memphis Pathology Group

Memphis Surgery Associates

Methodist Healthcare

Michael W. Goodman & Associates

Mid-South Ear, Nose & Throat

Mid-South Imaging & Therapeutics

Mid-South Surgical Associates

Morristown Heart Consultants

Morristown Regional Eye Center

Mountain Empire Eye Physicians

Mountain Empire Neurological Associates

MSK Group

• Memphis Orthopaedic Group

• OrthoMemphis

• Tabor Orthopedics

Nashville Fertility Center

Nashville Gastrointestinal Specialists Inc.

Nashville Oncology Associates

Nashville Surgical Associates

Nephrology Associates (Nashville)

Nephrology Associates (Chattanooga)

New Life Center for Bariatric Surgery

Northeast Tennessee Emergency Physicians PC

OB/GYN Center of Excellence

OrthoKnox

Pain Consultants of East Tennessee

Pain Medicine Associates

Pediatric Anesthesiologists, P.A.

Phillips Healthcare Group, Talbott

Plastic Surgery Center of Nashville PLLC

Plastic Surgery Group of Memphis

Plaza Urology

Pomerance Eye Center

Premier Surgical Associates PLLC

Primary Care Associates, Talbott

Psychiatric Associates of Kingsport

Seal & Lawrence

Semmes-Murphey Clinic

Shea Clinic

Siskin Spine and Rehab Specialists

Southeastern Retina Associates

Southeastern Retina Associates PC – Knoxville

Southern Oncology Inc.

Southern Surgical Arts

Specialists in Pain Management

Specialty Surgeons PC

Spine Surgery Associates

State of Franklin Healthcare Associates PLLC

Summit Medical Group Healthcare Services

Surgical Associates of Kingsport

Susong Dermatology

Sycamore Shoals Primary Care

Takoma Medical Associates

Tennessee Interventional & Imaging Associates

Tennessee Oncology

Tennessee Orthopaedic Alliance

Tennessee Reproductive Medicine

The Colorectal Center

The ID Group

The Jackson Clinic

The Plastic Surgery Group

The Skin Wellness Center

The Surgical Clinic

Tranquility Sleep Specialists PLC

Tri-Cities Skin and Cancer

University Oncology & Hematology Associates

University Surgical Associates

Urology Group

Vigilance Anesthesia, Elizabethton

Vista Radiology

Wellmont CVA

Wesley and Klippenstein PC

Wesley Neurology Clinic

Women’s Center of Greeneville

ALL-IN GROUPS

“The vision of TMA leadership is for a larger member base that enables us to accomplish more legislatively and provide more services and benefits for physicians in Tennessee. The recent growth is just the beginning of greater impact in our state.”

Jerome W. Thompson, MD, MemphisTMA Membership Committee Chair

“”

TMA’s legislative advocacy in 2015 focused on important public policies to address the state’s growing drug abuse problem and ease physician credentialing and patient steerage issues, among others.

And advocacy is most effective when physicians are involved. A rejuvenated grassroots effort engaged more TMA members in direct contact with lawmakers through events like the Annual Day on the Hill and Dialogues in the District.

Legislative SuccessesPassage of three important bills marked TMA’s success during the 2015 legislative session.

• The Addiction Treatment Act of 2015 provides Good Samaritan protections for individuals who experience a drug overdose or seek medical assistance for someone else who is experiencing a drug overdose, limits the prescribing of buprenorphine/naloxone and repeals law allowing an insurer to refuse payment to a healthcare provider for treating a patient who is under the influence of alcohol or illegal drugs.

• TMA worked with the Group Practice Coalition and the Neuro-Spine Committee to pass a new law to streamline the credentialing process for healthcare providers, improve beneficiary access to services and protect patient cost-sharing limits. The law requires insurance companies to pay for services at in-network rates if a physician has a credentialing application pending.

• TMA, along with the Tennessee Radiological Society, passed a patient steerage bill that protects a physician’s right to designate a preferred provider for medical service referrals, including imaging. The law also requires patients to be notified if their insurer or subcontractor steers them toward a provider other than their physician’s preferred referral.

Two groundbreaking bills saw activity during the 2015 legislative session and will again be priorities in 2016.

• A payer accountability bill to limit how often insurance companies can alter fee schedules and payment policies during a contract term stalled in the Senate Finance Committee and the House Finance Committee. If TMA is successful in passing the bill in 2016, it will be the first law of its kind anywhere in the U.S.

• The Tennessee Healthcare Improvement Act was also paused in 2015 in an effort for involved parties to discuss compromises. The bill would put in place a team-based healthcare delivery model with doctors as the team leader in patient care coordination.

TACKLING BIG ISSUES ON CAPITOL HILL

tnmed.org/advocacy

More than 200 physicians descended on Nashville in March for TMA’s Annual Day on the Hill, meeting with 93 legislators to discuss major issues affecting the medical profession in Tennessee and advocate for their patients.

TMA also provided 14 members to serve as volunteer Doctors of the Day. Participants serve the medical needs of lawmakers and their staff members for one day, and get the opportunity to interact with legislators and get a first-hand look at the legislative process.

Grassroots activity continued throughout the year, after the conclusion of the legislative session, with 20 legislators participating in TMA’s Dialogues in the District program. Small group meetings between legislators and TMA member constituents in their home towns help physicians and legislators develop meaningful relationships.

TMA gave members ample opportunities to get involved in a variety of grassroots efforts, with six legislative dinners, four continuing medical education classes and a number of legislative updates across the state.

PITCH (Physicians Involved in Tennessee’s Capitol Hill) Grassroots Network

“TMA’s government affairs team had another successful session passing some important bills, defeating some others and continuing to move forward with legislation that we intend to see through in 2016. All in all, we accomplished a lot for our patients and our physicians.”

Ronald H. Kirkland, MD, MBA, JacksonTMA Legislative Committee Chair

“”

tnmed.org/grassroots

During the break between election years, TMA’s political action committee continued supporting the election and retention of physician advocates in the Tennessee General Assembly, hosting and attending fundraisers for friends of medicine and delivering PAC checks throughout the state in preparation for the 2016 elections.

EVENTSIn October, IMPACT hosted a 2016 re-election fundraiser for Senators Steve Dickerson, MD (R-Nashville), Mark Green, MD (R-Clarksville) and Joey Hensley, MD (R-Hohenwald), as well as Representatives Sabi Kumar, MD (R-Springfield) and Bryan Terry, MD (R-Murfreesboro). Contributions totaled more than $18,000.

During TMA’s annual convention IMPACT also hosted an appreciation dinner with U.S. Rep. Diane Black (R-TN) and Sen. Green for five corporate donors: Core Physicians of Columbia, University Surgical Associates of Chattanooga, Southern Oncology of Nashville, Nephrology Associates of Nashville and Middle Tennessee Bone and Joint Clinic of Columbia.

CAMPAIGNSIMPACT supported 12 Senate candidates up for re-election in the general election in 2014 and all 12 won their races and went on to serve in the 2015 session of the General Assembly. In the House, 41 of the 44 candidates IMPACT supported were elected.

Sen. Richard Briggs, MD (R-Knoxville) and Reps. Kumar and Terry all served in their first sessions in the General Assembly in 2015 after running successful campaigns supported by IMPACT.

IMPACT SEES RESULTS IN 2015

tnimpact.com

Many Tennessee physicians will say that becoming a doctor is more of a calling than a profession. Physicians are healers who assume an enormous amount of privilege and responsibility the moment they take the Hippocratic Oath.

In that spirit, TMA members stay actively involved in the most important issues facing patients and impacting the state’s consistently poor public health status.

TMA representatives met in 2015 with the Tennessee Department of Health to lay the groundwork for a formal maternal mortality review process in Tennessee, and participated in ongoing efforts to curb the state’s prescription drug abuse epidemic. TMA also continues to support childhood vaccination efforts that have led to a less than 1% opt out rate on immunizations.

Patients, lawmakers and others naturally turn to doctors for expertise on sensitive and sometimes controversial healthcare issues like physician-assisted suicide and medical marijuana. TMA leaders studied these and other issues in 2015 to develop position statements that represent the will of the membership.

PROTECTING THE HEALTH OF TENNESSEANS

Morphine usage also saw a decline in 2014 and 2015.

1st Quarter Cumulative Morphine Milligram Equivalent Reported to CSMDM

ILL

ION

S

2,2492,390 2,429 2,377

2,116

2011 2012 2013 2014 2015

Year Opioids Change Benzodiazepines Change

2010 8,150,946 - 3,951,144 -

2011 9,018,139 10.6% 4,152,587 5.2%

2012 9,265,450 2.7% 4,061,418 -2.2%

2013 9,227,456 -0.4% 3,913,356 -3.6%

Prescriptions Reported to Controlled Substance Monitoring Database

Data shows the number of prescriptions for Opioids, Benzodiazepines going down in recent years.

tnmed.org/publichealth

LAWSUITS AGAINST SUPERVISING PHYSICIANSWhen the Tennessee Attorney General filed a false claims act lawsuit against a physician seeking funds for alleged illegal billings by his contract physician assistant (PA), TMA jumped in on behalf of physicians across the state. TMA submitted a joint amicus curiae brief in the case to argue whether state law requires a PA’s supervising physician to supervise the billing aspect of the PA’s practice rather than just the clinical aspect. In this particular case, The PA submitted TennCare billings through a third party billing company and the physician had no control over what bills were submitted. In September 2015, the trial judge ruled with TMA and the Tennessee Academy of Physician Assistants as a matter of law that a supervising physician is not responsible for the billing and coding practices of a physician assistant that he/she supervises. The time for an appeal is pending.

PHYSICIAN EMPLOYMENT CONTRACTINGThe TMA legal team developed a presentation on the pitfalls of employment contracting, along with a checklist for negotiations, to make sure that member employees understand what they are getting into. The checklist resource is free to TMA members and TMA legal staff produced a CME video as well.

ADVOCATING FOR DOCTORS IN THE LEGAL AND REGULATORY ARENAS

tnmed.org/issues

TELEMEDICINE ADVOCACYResponding to member concerns about some potentially troubling provisions in proposed medical board rules for telemedicine, the TMA legal team provided a voice to make sure the rules will not be overly restrictive for some safe patient telemedicine encounters. A final draft of the rules was released in July 2015 and will become final in 2016.

WORKERS’ COMPENSATION ADVOCACYThe Tennessee Division of Workers’ Compensation Medical Advisory Committee adopted TMA’s request to have a special Tennessee work group convened to develop treatment guidelines for shoulder, lumbar spine and cervical spine injuries.

FEDERAL REGULATORY ADVOCACYTMA protested the Administration’s decision to move ahead with Meaningful Use Stage 3 implementation when Stage 2 implementation has been an abject failure, and requested that Congress implement a transition period for ICD-10 to allow physicians and contractors to identify common errors, provide feedback and resolve system problems without resorting to claim denials.

OTHER NOTABLE LEGAL AND REGULATORY ACHIEVEMENTS IN 2015

• Stopping recoupment demands related to the primary care rate increase issued in error to dozens of Tennessee physicians who were board certified and did not need to file attestations.

• Advocating to allow maintenance of certification (MOC) courses to count toward state CME requirement for all specialties.

• Drafting legislation to make physician income information protected in Workers’ Compensation litigation.

• Launching new online “spotlight” videos on topics such as the professional privilege tax, continuing medical education requirements, and the new credentialing law.

• Developing proprietary member resources on retiring from practice, treating minors, credentialing law and physician employment contracting.

• Helping a member practice avoid having to cut its BlueCare patient panel due to a “non-discrimination” clause it its UHC contract. UHC has changed its interpretation of the contract’s non-discrimination clause.

TENNCARE PAYMENT REFORMA primary focus of TMA’s insurance advocacy in 2015 was the Tennessee Health Care Innovation Initiative, the state’s transition from fee-for-service to a value-based payment model. TMA testified during General Assembly hearings as to how the program could be improved, and advocated for physicians as TennCare managed care organizations started to reward or penalize providers based on quality and cost metrics

in the first wave of episodes of care. Several of TMA’s priorities have been adopted by the state as it continues to implement additional episodes of care. Moving forward, TMA’s advocacy remains focused on transparency and consistency in the data and reporting process, and making sure TMA member physicians have an influential voice on Technical Advisory Groups for each episode of care.

AN INTERMEDIARY FOR DOCTORS AND PAYERS

In June 2015, TMA welcomed Ms. Jackie R. Woeppel, ScD, MBA to its staff in the newly created position of Tennessee Health Care Innovations Consultant. She will help practices understand and use their provider episode reports, evaluate problems with report data and advocate with the State and health plans for improvements to the payment reform initiative. Learn more at tnmed.org/paymentreform.

Three episodes of care launched: 1. Acute Asthma Exacerbation 2. Perinatal 3. Total Joint Replacement (Hip and Knee)

· Performance period for Wave 1 episodes· Wave 2 episodes preview reports released· Technical Advisory Groups convened for Wave 3 and Wave 4 episodes

• Payments or penalties for Wave 1 episodes based on 2015 performance

• Performance period for Wave 2 episodes

o Acute COPD exacerbation

o Screening and Surveillance Colonoscopy

o Outpatient and Non-Acute Cholecystectomy

o Acute PCI

o Non-Acute PCI

• Preview period for Wave 3 and Wave 4 episodes

Episode-based payment, part of the Tennessee Health Care Innovation Initiative, has the goal of aligning incentives with achieving a patient’s desired outcome during an episode of care.

Wave 4 episodes are in development. The state has a goal of implementing 75 episodes by the end of 2019.

2014

2016

2015

tnmed.org/paymentreform

MEDICAID PCP RATE BUMP AUDITSHundreds of primary care physicians, mainly in rural areas, received recoupment letters in 2015 saying they owed tens and even hundreds of thousands of dollars because they did not meet a certain threshold based on a calculation formula provided by CMS. TMA protested the audits and the manner in which they were conducted, advocating directly with TennCare, CMS and the Tennessee congressional delegation, and launching an unprecedented grassroots advocacy effort to pressure CMS into re-auditing using fairer methodology. TMA helped dozens of PCPs avoid the recoupments. As of publication time, approximately 140 physicians and 40 mid-level providers remained subject to recoupments totaling more than $7.5 million.

RAC AUDIT FAIRNESSTMA worked with the Physician Advocacy Institute, Inc. to draft proposed federal legislation that would ensure fairness and transparency in the federal government’s efforts to identify overpayments and prevent fraudulent claims. Rep. George Holding (N.C.) filed the Fair Medical Audit Act in May based on PAI’s draft bill. HEALTH PLAN NETWORK ADEQUACY

In 2015 TMA advocacy staff met with state agency officials to ensure that physician networks are adequate, reached out to the major health plans to learn about their perspectives in narrowing networks and began working with the National Association of Insurance Commissioners to draft model state standards for network adequacy.

OTHER NOTABLE INSURANCE WINS IN 2015:

• Partnered with UnitedHealthcare through its newly established Physician Advisory Council to improve its relationships with practices and physicians.

• Fought for increased graduate medical education funding in Tennessee.

• Convinced Governor Haslam to not include a 4% across-the-board provider cut in TennCare reimbursement.

• Demanded that Congress repeal the Independent Payment Advisory Board created by the ACA, advocated that Congress implement a transition period for ICD-10, and protested the Administration’s decision to move ahead with Meaningful Use Stage 3 implementation.

• Discovered errors in a primary care rate bump audit saving a handful of TMA members thousands of dollars in recoupments.

• Resolved several issues with incorrect fee schedules, enabling practices to obtain retroactive payments.

“Modern physicians are ill suited and trained to decipher many of the contractual issues

we face with insurers. As we continue to transition to value-based care, TMA is taking an active role in protecting and representing

the physicians in Tennessee.”

David K. Helton, MD, Chattanooga TMA Insurance Issues Committee Chair

“”

tnmed.org/insurance

TMA in 2015 took advantage of its first full year of ACCME accreditation by increasing its in-person and online medical education content for Tennessee physicians and their staff.

ICD-10Nearly 1,000 people took part in TMA’s coding camps held in six major markets across the state. The statewide events were the culmination of TMA’s ICD-10 education efforts during the past four years to help practices fully prepare for the Oct. 1, 2015 transition. Additional resources, including online training by specialty, customized chart audits and an ICD-10 line of credit, remain available online at special pricing for TMA members.

The low volume of calls to TMA following the Oct. 1 transition date indicates that ICD-10 education efforts were largely successful.

MedTenn15Approximately 300 physicians and other healthcare professionals attended TMA’s annual convention at the Opryland Resort & Convention Center in Nashville in April. Participants had access to 21.5 hours of continuing medical education on topics like updates on workers’ compensation treatment guidelines, vaccines and cancer prevention, medication safety for older patients, Alzheimer’s and dementia and the pitfalls in physician employment contracting.

Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, FACOEM, spoke to attendees about Tennessee’s biggest public health challenges, a panel of physician experts held a discussion on end-of-life care, TMA’s in-house experts delivered two presentations on the Tennessee Healthcare Innovation Initiative and Roland Gray, MD of the Tennessee Medical Foundation delivered a session on Tennessee’s growing prescription drug abuse epidemic.

EXPANDING MEDICAL EDUCATION OFFERINGS

April 28 - May 1, 2016Murfreesboro

tnmed.org/medtenn

NEW ONLINE CMETMA’s in-house healthcare attorneys produced new online CME courses tackling two issues which are shaping the way healthcare is provided in Tennessee – the increasing number of employed physicians and the move from fee-for-service to value-based reimbursement.

“Tennessee Health Care Innovation Initiative 101” gives an overview of the state’s retrospective episodes of care and value-based payment models, an introduction to patient-centered medical homes and a look at how the primary care landscape will be shaped by the state’s emphasis on population health.

“Pitfalls in Physician Employment Contracting” is a guide for physicians to use when considering entering into an employment relationship, including the risks and benefits of traditional employment relationships and newly-invented relationships with institutional employers.

“This has been a very exciting year of growth and program development in the education division at TMA with great things planned for 2016. Physicians now have a wonderful resource for quality, accredited CME through their state medical association.”

James “Pete” Powell, MD, MMHC, Franklin TMA Education Committee Chair

“”

tnmed.org/education

There is an immediate and pressing demand for more physician leaders in the emerging team-based healthcare environment. This year, the TMA – in partnership with the Tennessee Medical Education Fund, Inc. – responded to the changing healthcare landscape by enhancing its offerings to members who want to grow their leadership skills, and for healthcare organizations looking to groom physician leaders.

The former TMA Physician Leadership College was expanded and repackaged with new programs, including an intensive leadership retreat and a multi-month course called the Physician Leadership Lab. Those offerings were rebranded under the John Ingram Institute for Physician Leadership and officially launched in May 2015 with a gala to honor Dr. John J. Ingram III of Maryville, who helped create the PLC nearly a decade ago.

TMA operates the Ingram Institute in partnership with the TMEF and underwrites 90 percent of the costs for physicians to participate.

Final graduating class of TMA Physician Leadership College, 2015

LEADERSHIP TRAINING BEGINS NEW CHAPTER

Ingram Institutefor Physician Leadership

John

John J. Ingram III, MD, Maryville Founder of TMA Physician Leadership College (now the John Ingram Institute for Physician Leadership)

LEADERSHIP IMMERSION WEEKEND RETREAT The inaugural class of the Leadership Immersion Weekend participated in a retreat in Nashville on July 23-26. Six physicians graduated from the program, and TMA awarded 19.5 hours of continuing medical education on topics like teamwork, collaboration, conflict resolution and media communications.

The 2016 Leadership Immersion Weekend Retreat will take place June 10-12 in Monteagle and July 15 in Nashville.

PHYSICIAN LEADERSHIP LABThe Physician Leadership Lab includes a quality improvement project to help participants improve their leadership skills in team care environments. The first Lab began on Dec. 10, 2015 and runs through July 15, 2016. The full class of 30 physicians enrolled in the 2015-2016 course will earn 27 CME hours through a mix of webinars, live workshops, and a final meeting and project presentation to the TMA Board of Trustees.

TMA intends to further expand its Leadership training in the future with a third program focusing on business practices, finance analytics and related skills.

tnmed.org/leadership

Graduates of the inaugural Leadership Immersion Weekend, 2015

The size, scope and complexities of healthcare in Tennessee requires industry groups to work together. Sometimes it is the only way to overcome challenges on Capitol Hill, or bring about change on important public health issues. TMA because of its influence and core mission routinely participates in consortia that share overarching goals of improving both the business and clinical sides of medicine.

In 2015, the volunteer committee tasked with forging and maintaining productive industry relationships continued its work with the Tennessee Nurses Association to advocate for better end of life care. They submitted feedback to improve the Tennessee Department of Health’s Advance Directives form, and began working with the Tennessee Commission on Aging and Disability and Tennessee Department of eHealth Initiatives to promote more widespread advance directives use among patients and providers.

Three resolutions from the 2015 House of Delegates call for interprofessional collaboration, including supporting advocacy efforts to increase Graduate Medical Education funding in Tennessee and address the current and future physician shortage, education programs to mitigate health disparities, and opening a dialogue with other industry stakeholders to proactively manage drug shortages.

Work that began in 2015 continues toward strengthening ties with medical specialty societies, and elevating TMA’s role in the fight against prescription drug abuse.

COLLABORATING FOR THE GREATER GOOD

“Relationships are all about finding similarities and respecting differences.”

Elise Denneny, MD, Knoxville TMA Professional Relations Committee Chair “ ”

One of the lesser known and underutilized perks of TMA membership is access to a variety of professional products and services at preferred pricing.

TMA Physician Services is a subsidiary created to identify, vet and maintain relationships with companies to offer members exclusive deals on the business resources they want or need to practice medicine.

Revenue generated by Physician Services programs, along with TMA’s generous corporate partners, helps offset TMA’s operating expenses and fund other important programs like advocacy, legal resources and education.

TMA Insurance and TMA Medical Banking continued in 2015 as the top two corporate partners in terms of member activity. A new third party relationship also laid the groundwork for a product that has the potential to save member practices tens of thousands of dollars in annual health insurance costs. That product will continue to develop and be market ready in 2016.

Two new corporate partners joined the fold in 2015 – Tennessee Drug Card and Jackson Thornton Technologies – to round out a total of eight corporate partners covering the areas of insurance and financial services, professional and business services, human resources and personnel services, and technology.

Physician members and their office staff can support TMA and save time and money by taking advantage of the programs available through TMA partner companies.

MAKING THE MOST OF MEMBER BENEFITS

THANK YOU TO OUR 2015 CORPORATE PARTNERS

tnmed.org/marketplace

2015 FINANCIAL OVERVIEW

2015 PROJECTED INCOME:

$3,475,800

52% - TMA Membership Dues

11% - SVMIC Royalty

10% - Education & CME Activities

N/A% - Settlement Revenue

8% - Physician Services

4% - Headquarters Rent & Lease Income

4% - Specialty Society Management

3% - Annual Meeting

3% - Print & Digital Advertising Income

2% - Corporate Sponsorships

1% - Subsidiary Administration

1% - Investment Income

0.6% - Information Systems User Fees

0.1% - Other / Misc.

$1,834,879.38

$1,800,000.00

$375,000.00

$375,000.00

$112,300.00

$118,507.67

$125,000.00

$266,000.00

$50,000.00

$19,115.00

$332,000.00

$554,955.50

$108,500.00

$91,091.00

$148,000.00

$105,534.31

$35,000.00

$28,927.27

$N/A

$312,500.00

$76,000.00

$72,185.00

$145,000.00

$83,890.01

$22,000.00

$14,000.00

$6,000.00

$83,175.69

*Unaudited as of Dec. 1, 2015.

= Projected

= Actual

2015 PROJECTED EXPENSES:

$3,489,430

52% - Personnel

6% - Headquarters Expenses

6% - Governance and Leadership

6% - Association Communications

4% - Education & CME Activities

4% - Contributions to TN Medical Education Fund and TN Medical Foundation

3% - Information Systems

3% - Specialty Society Staffing

3% - General Operations

3% - Annual Meeting

3% - Advocacy

2% - Member Services and Marketing

0.7% - Financial Management Fees

0.4% - Executive Office

$1,964,148.00

$1,816,902.91

$218,450.00

$209,400.00

$192,500.00

$125,000.00

$103,277.28

$96,850.00

$93,250.00

$90,950.00

$86,750.00

$26,000.00

$14,900.00

$241,707.04

$207,375.90

$123,602.36

$284,399.08

$117,000.00

$145,876.46

$150,953.61

$175,934.50

$78,648.95

$175,370.55

$128,600.58

$77,444.04

$11,989.27

$64,867.41

$10,902.21

*Unaudited as of Dec. 1, 2015.

= Projected

= Actual

A wide-ranging list of healthcare topics displayed on a screen during the July 2015 TMA Board of Trustees meeting prompted a vigorous discussion about the biggest issues facing physicians, and TMA’s role in each. From that exercise the Board identified several areas of focus.

Tennessee faces a two-way challenge in terms of diminishing physician supply, and expansion of scope for other providers to meet increasing demand, especially in primary care. TMA must be the voice to make sure physicians remain the team leaders as these changing market dynamics impact the delivery of care. We will continue working to increase GME funding, define roles and responsibilities of caregivers to avoid redundancies, improve efficiency and generate the best possible patient outcomes.

Alternative payment models will keep us all busy, as the state expands on the Health Care Innovation Initiative, and government and commercial payers move full bore into value-based reimbursement. Like most anything new, we will experience some good and bad, but TMA is an advocate and resource for doctors wrestling with changing and often shrinking reimbursement.

When we examine Tennessee’s public health, we point to population health management as the key to advancing quality of care and achieving better patient outcomes. But its success is totally contingent on sharing information, and we still have a long way to go toward interoperability. We need functioning health information exchanges that make patient data transportable across entities and not just within a group or siloed healthcare system. TMA has a role to play in bringing more actionable information to physicians who provide care.

End of life care is becoming a monumental issue as baby boomers reach senior status and people live longer. We have to participate in discussions around medical ethics and reconcile governmental regulations with the practical challenges of caring for patients in their final phase of life. Physicians are in the best position to do that.

Although we’ve been dealing for years with controlled substance abuse at the state level and are making some headway, it’s not enough. The prescription drug abuse epidemic is accelerating rapidly on a national level and, sadly, Tennessee’s problem is still among the worst of any state.

Medicaid expansion is not going away, either. We are going to have to put politics aside and come to grips with how to address the uninsured and underinsured populations. We have to keep people

healthy and working to improve our public health, control healthcare costs and stimulate our economy.

Looking inward, we must acknowledge that for the past two decades the various factions of organized medicine have drifted apart, clutching different perspectives to justify fighting issues in a vacuum. The issues, meanwhile, are getting bigger and more universal. We have to come together as physicians to handle them with decorum and professionalism if we are to arrive at any resolution.

If ever there was a time for physicians to engage in their state medical society, it is now.

LOOKING AHEAD

Russ Miller, CAETMA Chief Executive Officer

2301 21st Avenue South | Nashville, TN 37212 | 615.385.2100tnmed.org | @tnmed | facebook.com/TNMed